April 2017                                                                                                                     ISSN 2423-0561

Hello everyone and welcome to the latest edition of our newsletter.  Summer is over – we hope you managed to grab some time out to relax, regroup and refresh and are ready for another stimulating year.  

In this newsletter, we have included highlights from the sector and news from the team including: a link to an article about nurse prescribing; updates on  enrolled nurses, the Ministry of Health Health Symposium, the Nursing and the New Zealand Health Strategy meeting; and stories from primary health care, mental health  and the aged care sector. Read also about Tim Ryan (RN) who, along with his colleagues and the men themselves, has developed a new programme to assist Māori men with long-term conditions.

We welcome feedback or questions about any items in the newsletter – to contact us, please email: andrea.tamahaga@moh.govt.nz

New team members

Our two new team members, Dr Jill Clendon and Carolyn Jones, have settled in well.

Jill Clendon has taken on responsibility for the child and family and primary care portfolios within the Office of the Chief Nurse (OCNO) and will be working on the Well Child / Tamariki Ora review (see further below) and the Better Public Service targets in both these areas. Jill is also keeping abreast of RN prescribing and the development of the electronic health record.

Carolyn Jones is assisting the NNO group to organise the Nursing and the New Zealand Health Strategy meeting as well as working with others in the Ministry on the Comprehensive Performance Framework.

Jill Clendon (left) and Carolyn Jones are pictured below in the OCNO office.

Health Symposium

On 21–22 February, more than 200 people at the forefront of health and social services delivery in New Zealand attended the Ministry of Health’s second New Zealand Health Symposium, with its theme of Explore, Innovate, Transform. Over two days presentations covered the impact of fast moving technologies – referred to collectively as exponential technologies because of their rapid growth – as well as disruptive innovation and the leadership needed to tackle the challenges and opportunities we face so that all New Zealanders can live well, stay well and get well.

This was followed with a Ministry of Health Leaders’ Forum, giving more than 100 Ministry staff the opportunity to learn from the presenters who had spoken at the Symposium. 

The Ministry has a critical role in providing stewardship and leadership. It’s about taking responsibility for our health system and being responsive, developing a better understanding of what it’s like to use our health system and all the variables and levers that drive positive outcomes. It’s about working well with others because we can’t succeed in silos. 

Many nurse leaders from across the sector, as well as our team at OCNO, attended the Symposium or Forum and came away motivated, ready to engage in, and help lead important health sector transformation.

Pictured above: The Ministry of Health’s Te Kōnohete Waiata Group performing at the Leaders Forum – including OCNO’s Andrea Tamahaga. Front row: left to right: Vera Schmidt, Alice Ropata, Andrea Tamahaga. Back Row:  Ana Bidois, Marea Johns, Mary Kearns, Jim Nicholson (you can only see his feet). Guitarist:  Arthur Selwyn.

Nursing and the New Zealand Health Strategy – Preparing for the future

The National Nurses Organisations (NNO), the Nursing Workforce Governance Group (NWGG) and OCNO have organised a gathering to be held on 20 April 2017 at the Ministry of Health. The theme of the meeting is Nursing and the New Zealand Health Strategy – Preparing for the future.  

The meeting is a beginning discussion to imagine what health care is going to look like in the future and how we can prepare.

Nursing leaders from around the country will be attending as well as representatives from iwi providers, Pacific health, allied health, medicine and Department of Corrections. 

Enabling nursing practice

In November 2016, eight separate acts of parliament were amended to enable suitably qualified health practitioners to carry out some activities previously only able to be done by doctors. This work was previously known as the Health Practitioners Statutory References Bill. Full information on this is now available on the Ministry’s website: www.health.govt.nz/about-ministry/legislation-and-regulation/changes-health-practitioner-status

The OCNO has written a short article on improving access, enabling nurses and removing barriers, in Handover magazine which discusses registered nurse prescribing in the context of mental health nursing. You can access the article here: www.tepou.co.nz/uploads/files/resource-assets/Handover-Dec2016_f_WEB.pdf

Enrolled nurses

We know that the employment of new graduate enrolled nurses (EN) has been variable across regions. The 2017 Ministry of Health Regional Service Planning Guidance regarding workforce now states that regions are expected to know their workforces in training (including ENs) and have plans to employ them. Some DHBs are making good progress in this area. For example, Capital & Coast and Waikato have begun actively employing enrolled nurses in mental health settings after many years when the psychiatric assistant was the established workforce that worked alongside registered nurses.   

We are always happy to hear stories about how DHBs are employing ENs such as the examples below.

ENs in Waikato DHB

The Mental Health and Addictions Service (specifically Older Persons Rehabilitation) at Waikato DHB has developed a comprehensive approach to employing ENs. Charge nurse manager, Marie Dickinson and clinical nurse specialist Janine Burton worked to ensure their RN workforce understood the EN scope and roles including how to support ENs into the older persons rehabilitation environment. In 2015 they developed a tailored learning package with Sarah Haldane from the Professional Development Unit. This led to an increase in enrolled nurses employed across Waikato mental health services.  Waikato now have eight ENs in mental health settings including four enrolled nurses in older persons rehabilitation services. Nearly every shift has an EN on duty. 

Older persons rehabilitation service nurses: Left to right: Marika Avison (RN), Augeshni Bondad (EN) and Manju Aryal (RN)

Carole Kennedy, nurse director, explains that developing the guiding documents so that all staff were aware of their roles and responsibilities and developing a robust orientation programme for ENs, have been pivotal to the initiative’s success. 

‘ENs have higher education, are regulated, and are accountable for their practice. RNs working alongside ENs has enabled discussions about cases including critical thinking, and reflection supportive of best practice. Their skills benefit the service users’ care everyday,’ said Marie Dickinson, charge nurse manager.

ENs and interRAI

A 2015 pilot completed by the Aged Residential Care Comprehensive Clinical Assessment (interRAI) Project in collaboration with OCNO showed that ENs were able to achieve competency in Long-term Care Facilities Assessment (LTCF) at similar rates to RNs. 

ENs are eligible to complete the interRAI training where the facility can allocate a RN to provide ongoing supervision. RNs remain a high priority group for training in interRAI but as numbers of RNs who are trained continues to grow, there will likely be increasing opportunities for ENs who have the support of their facility to train in interRAI. 

Information about education and training for interRAI is available on the Central TAS website. 
www.interrai.co.nz/education-and-support/
www.interrai.co.nz/register-for-training/

Stories from the sector – Primary and community health

Innovation programme for Māori men – Tane Takitu Ake 

Long-term conditions nurse Tim Ryan is taking a different approach to help Māori men change health behaviours to improve management of their long-term conditions and overall health. Tim has co-designed the Tane Takitu Ake programme along with Tracy Ormsby, Aaron Randel, Dean James and a group of Māori men. The programme is for Māori men with high health and social needs and is run by Korowai Aroha Health Centre, a kaupapa Māori health service in Rotorua.  

Tane Takitu Ake means to stand up together as men, and the focus is Māori men helping Māori men to realise their full potential. Participating men are taken on a journey that is supported by the Pae Whiriwhiri, their peers in the programme, and those who have previously engaged with the programme. Tane learn about self-management of their health conditions, develop peer networks, and gain skills and knowledge of Māori culture to confidently sustain health behaviours and realise and optimise their role in their whānau and community. 

Participants in Tane Takitu Ake.

Through the combination of wānanga, physical activity, peer support and holistic support, Tane Takitu Ake encourages tane, and their whānau, to improve all four aspects of their health; whānau (family health), tinana (physical health), hinengaro (mental health) and wairua (spiritual health).

An underlying belief is that the answer lies within our past and returning to basic yet simple life principles will help us in the future. Connecting through culture and teaching helps men gain improved health and wellbeing and assists men to be good partners and good fathers so that the whole whānau will flourish.

Tim explains, ‘The Tane Takitu Ake programme demonstrates a perfect blend of traditional medicine with cultural concepts that together, produce a tane that has deeper understanding of his holistic wellbeing’. 

Programme outcomes include not only improved clinical markers (such as HbA1C, cholesterol and waist circumference), action plans for lifestyle changes, and an improved understanding of what it means to be well, but also a growth in confidence that has seen tane becoming more actively involved at appointments, champions for a range of causes, and leaders and role models for the wider iwi and hapū.

The quotes below are from some of the men who have been through the programme.

‘. . .my whole whānau eat healthier and we all exercise together . . . ’

‘. . .I would like to thank you guys . . . you have given back my Tāne . . .’ (partner)

‘ . . . not only has this course brought me out of my shell . . . it has done much more, it has given me tools to better our lives and be healthy . . .’

For more information see http://korowai.org.nz/portfolio/tane-takitu-ake-service/

Alexandra’s ‘Central Way’ initiative for support workers and registered nurses

RNs at the Alexandra office of HealthCare NZ (www.healthcarenz.co.nz) have developed a new initiative to ensure timely escalation of concerns about a client’s condition by support workers.

The Central Way includes a RN drop-in clinic where support workers can ask questions and raise concerns about individual clients and their care. RNs also provide professional development and training for support workers around use of the Stop and Watch tool (used to identify a change or deterioration in a client’s condition). 

The Stop and Watch tool is popular with support workers as it teaches them to notice change rather than require them to carry out an assessment of the client. As a result, support workers are increasingly reporting concerns.

Example: A support worker found a client who had slurred speech. She used the Stop and Watch tool. Worried the client had had a stroke, she activated their St Johns alarm and called the office immediately to seek further advice.

The Central Way has improved role clarity and communication within the team. Most importantly there has been an increase in timely escalation of concerns from support workers. 

Further information is available from Christine Maxwell RCpN, MN, NP(Mental Health) director of nursing at Healthcare Holdings Ltd.

Note: HealthCare NZ has sought permission from Florida Atlantic University to use the Stop and Watch Tool.

Other news and information

Well Child / Tamariki Ora review

As part of a continued focus on ensuring all children and their families receive core services, Cabinet has directed the Ministry to review the content, timing and delivery of the core/universal health services for 0–5s. 

Beginning with the Well Child / Tamariki Ora programme, the review seeks to ensure universal services are built on evidence about what works, reflect key priorities, and are able to be delivered in sufficient intensity to meet identified need. Significant updates will be placed on the Ministry’s website and we will provide a link to the page once set up. Jill Clendon will be supporting this work on behalf of the Office.

InteRAI evaluation

Lessons learned from the introduction of Comprehensive Clinical Assessment (interRAI) in Aged Residential Care (2011–2015).

An independent review of the introduction of interRAI in Aged Residential Care (ARC) has now been finalised and provides useful insights.

The full report provides a set of recommendations and a roadmap for future direction. The review found interRAI assessments have led to: 

• more consistent assessments providing support for clinical and care planning decisions that raise the quality of care for older people
• improved relationships between ARC and Needs Assessment Service and
  Co-ordination (NASC). A shared terminology has been one benefit, along with new skills for RNs.

Providers suggested changes to the interRAI training model to improve sustainability and noted a lack of interoperability between InterRAI and care planning and double entry of data as reducing efficiency. Frustrations with interRAI technology and workload were also noted by participants however NASC managers were positive about efficiency gains.

The evaluators recommended: 

• a communications strategy
• changes to the training model 
• improving integration of assessment and care planning 
• investigating information flows between the tool and care plans. 

You can read the full report here: http://www.interrai.co.nz/news/

Latest ACE news

Māori graduates are being recruited at a faster rate than the overall rate of nursing graduates. This is very good news as the increase in Māori new graduates will help better reflect the population nurses serve. This year, 71 percent of the 223 Māori nursing graduates were employed within three months of the November recruitment round.

Latest figures show that of the 1455 November applicants, 853 have now been employed thorough ACE (as at 1 March 2017). In addition 39 withdrew, (20 of these were employed prior to the match) and 12 declined positions.

The table below shows the practice setting in which graduates have been employed, as at 1 March, 2017.

If you are interested in more detail on the ACE figures, please contact us at the OCNO office.

Mental Health and Addictions Workforce Plan

In February the Mental Health and Addictions Workforce Plan was published on the Ministry’s website: www.health.govt.nz/publication/mental-health-and-addiction-workforce-action-plan-2017–2021. The Plan is structured around a workforce with the right skills, knowledge, competencies and attitudes needed to design and deliver integrated and innovative responses. 

Safe Practice Effective Communication (SPEC) training

As part of nationally consistent de-escalation and restraint minimisation training, 97 Safe Practice Effective Communication (SPEC) trainers have been trained across the country so far. Plans for 2017 include the roll out of further train the trainer workshops, ongoing support for national consistency and best practice development. Jane Bodkin is now on the governance group for the SPEC collaborative. 

The Counties Manukau DHB (CMDHB) SPEC team recently won a national Award for Learning and Development Capability in the Public Sector. This was awarded for recognition of excellence in outstanding training and development initiatives that have contributed significantly and strategically to organisational capability outcomes in the public sector, central and local government and other Crown agencies. The award was made by the Human Resources Institute of New Zealand.

Congratulations to CMDHB SPEC team! A worthy award and public recognition for great work.  

The Counties Manukau DHB SPEC team at the award presentation. From left: Denise Black CMH; Adele McLean Industry Manager, State Sector; The Skills Organisation; Kathy Moore CMH; Alasdair Hastings CMH; Richard Webber CMH

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